Impressions from South Africa

Even now, two months after the close of the 13th International AIDS Conference in South Africa, I still sense a certain feeling of bewilderment among my medical colleagues about all that happened. Being exposed to the harsh reality of life in South Africa brought a lot of us up short and, hopefully, lent a new perspective to our work.

Coming of age in what feels like the distant past, our feelings toward South Africa were pretty straightforward. Apartheid was in firm control, we all read Cry the Beloved Country, bought Miriam Makeba albums and supported the boycott. With the recent miraculous change in government and the ascent of Mandela, we all hoped that peaceful progress could happen.

Visiting South Africa, I was overwhelmed by many conflicting feelings. The countryside is gorgeous. The stark mountains of the Cape area, the beauty of Capetown and the lushness of the wine country clash jarringly with the black shantytowns, the palpable fear of crime in the cities, and the monstrous economic gulf that exists between blacks and whites. The statistics are mind numbing. This is a country with almost 50% unemployment. Whites are leaving in droves. Most of the land and most of the wealth is definitely not in the hands of most of the people. And an ever-increasing percentage of those are HIV-infected.

Being a guest in another country should temper one's usual hypercritical New York attitude. After all, it's a different culture, there are different demands and priorities, not everything from the West is the best, what makes you think you know it all? But then, printed in a South African daily newspaper was an exchange of letters, a debate between South Africa's President Thabo Mbeki and a science correspondent. And President Mbeki was persisting in distorting scientific reality to mask his political failure as a leader of his people.

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If you've read this far, you may be asking yourself, "what does this have to do with AIDS research?" Well, that depends. Many of us clinicians got into AIDS research because we suddenly had many patients dying of a new disease that didn't even have a name. In order to help our patients we began, resumed or intensified familiar activities in politics, social activism, research and public health. Those of us working in the inner cities intensified our efforts to make good health care available to the medically uninsured. Issues of jobs, education, crime, drug abuse, inadequate resources, ignorance and racism were exposed and addressed. Good health care in AIDS also meant good research and the access to new drugs, new prevention methods and new clinical knowledge that comes with it.

Most of us clinicians got into AIDS research to find ways to help our patients. With time, this initial clarity often became blurred, diluted by other issues, both personal and professional. For me at least, South Africa restored that clarity and then some. The meeting has been widely criticized as having been somewhat light on science. Actually, that criticism has been made of every international AIDS meeting since the first one in Atlanta in 1985. The feeling that the "purity" of science is attacked by allowing all those "nonscientific community people" to attend the meetings is still present among a good number of so-called scientists. The issue that became abundantly clear in South Africa was that merely having the meeting in South Africa saved lives.

AIDS research has made incredible progress when measured against the usual timelines existent with other diseases. Current antiretroviral therapies, the product of AIDS research, are restoring health to many people infected with HIV. But not in Asia, Africa, parts of Europe, the Caribbean and South America. At least, not among the vast majority of the poor of those regions who are infected with HIV. Without radical change, as many as ten million South Africans will die in the next ten years.

Science has a responsibility to society. Society has given us the means (money) to do our work. We have repeatedly seen what happens when science operates in a vacuum. We as scientists have a responsibility to society to make sure that our work can affect the good that is its goal. Having discovered increasingly effective (somewhat) treatments for AIDS, we must take the next step and ensure that these treatments are available to all. Welcoming all those "nonscientific community people" to our meetings is one step. Their energy and commitment have done wonders in changing the course of the epidemic. Having our meetings in countries where the epidemic is most prevalent is another. The public attention brought to the failure of the government of South Africa to engage the issue of HIV in a responsible manner will save lives. The continuing exposure of the extent of the epidemic is galvanizing local prevention efforts. The exposure of the issues of drug company profits and wealthy countries' greed will also bring about change.

True, there is little medical infrastructure in South Africa. But some of my best teachers in medical school were trained in South Africa. It is a dirty trick for the government there to use the current situation as an excuse for inaction. As an activist pleaded during a session at the conference: just begin to distribute the drugs, the infrastructure will follow. While we continue working on improving drugs, developing better treatment strategies, enhancing prevention efforts and working on vaccine development, we must also make sure that the results of our efforts, anxiously awaited by so many, are made widely available.

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